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� . SEWAG , <br /> Distance to Public Sewers Connection necessary: Yes No— <br /> Does existing septic system comply with Ord . 0549 : Yes No_ <br /> Unknown If no, explain: <br /> Describe septic ;; nstallation to be installed: <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes o Is well proper: <br /> Yeses No State deficiency : <br /> Does existing or porposed use make this well public water: Yes <br /> No Sample of well water taken: Yes ilo Da �a�n����. <br /> Results Additional information or comments <br /> G/ cg r <br /> 3 . GARBAGE & REEUSE <br /> Licensed scavenger pick-up: Yes No Service Area No . <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . =I _ MOSQUITO OR VZQTQR POfL-nT_TAj1t <br /> State possible vector potentiitl & necessary control : <br /> 5 . TOILET/BATH FACILITES ��- <br /> No . & location existing : _ Additional <br /> facilities needed _ <br /> 6 . PREVIOUS OPERATIQU �'C) <br /> � r /� <br /> -Ael <br /> k�fC/ / <br /> VL A2,ae r <br /> 7 . GENERAL SANITA`1'3'ON <br /> State an,, problems nat previously rioted: � <br /> 8 . pit ' 1LATION Dr'jY <br /> Appx. No . People per rq . mi . _ <br />